First Edition: January 23, 2019

Kaiser Health News: Alcohol-Linked Disease Overtakes Hep C As Top Reason For Liver Transplant
An estimated 17,000 Americans are on the waiting list for a liver transplant, and there’s a strong chance that many of them have alcohol-associated liver disease. ALD now edges out hepatitis C as the No. 1 reason for liver transplants in the United States, according to research published Tuesday in JAMA Internal Medicine. One reason for the shift, researchers said, is that hepatitis C, which used to be the leading cause of liver transplants, has become easier to treat with drugs. (Bluth, 1/22)

California Healthline: Doctors Call California’s Probe Of Opioid Deaths A ‘Witch Hunt’
The Medical Board of California has launched investigations into doctors who prescribed opioids to patients who, perhaps months or years later, fatally overdosed. The effort, dubbed “the Death Certificate Project,” has sparked a conflict with physicians in California and beyond, in part because the doctors being investigated did not necessarily write the prescriptions leading to a death. The project is one of a kind nationally, although a much more limited program is operated by North Carolina’s board. (Clark, 1/22)

The New York Times: Supreme Court Revives Transgender Ban For Military Service
The Supreme Court on Tuesday granted the Trump administration’s request to allow it to bar most transgender people from serving in the military while cases challenging the policy make their way to the court. The administration’s policy reversed a 2016 decision by the Obama administration to open the military to transgender service members. It generally prohibits transgender people from military service but makes exceptions for those already serving openly and those willing to serve “in their biological sex.” (Liptak, 1/22)

Reuters: Trump Transgender Troop Limits Can Take Effect, Top Court Decides
The decision, with the court's five conservative justices prevailing over its four liberals, granted the Trump administration's request to put on hold injunctions issued by federal judges against enforcement of the policy while a challenge to its legality continues in lower courts. The court did not resolve the underlying question of the legality of the Republican president's plan, which reversed the landmark 2016 policy of his Democratic predecessor Barack Obama to let transgender people for the first time serve openly in the armed forces and receive medical care to transition genders. (Chung, 1/22)

The Washington Post: Supreme Court Allows Trump Restrictions On Transgender Troops In Military To Go Into Effect As Legal Battle Continues
The courts were considering a policy developed by then-Secretary of Defense Jim Mattis, who issued a plan to bar from the military those who identify with a gender different from their birth gender and are seeking to transition. Mattis’s plan makes exceptions for about 900 transgender individuals who are already serving openly and for others who say they will serve in accordance with their birth gender. (Barnes and Lamothe, 1/22)

NPR: Supreme Court Revives Trump's Ban On Transgender Military Personnel, For Now
The transgender ban is being revived more than a year after a federal court in Washington, D.C., first blocked it in October 2017. U.S. District Judge Colleen Kollar-Kotelly ruled that trans members of the military had "a strong case that the president's ban would violate their Fifth Amendment rights," as NPR reported. A three-judge panel of the U.S. Court of Appeals for the District of Columbia Circuit lifted Kollar-Kotelly's injunction earlier this month, concluding that the ban had been substantially revised by the time it was instituted by former Defense Secretary Jim Mattis in March 2018. But other federal courts had also ruled against the ban — and until Tuesday, those other injunctions remained in place. (Welna and Chappell, 1/22)

The Associated Press: Q&A: Impact Of Supreme Court Decision On Transgender Troops
Some questions and answers about what the high court did. (1/23)

NPR: From Cover-Ups To Secret Plots: The Murky History Of Supreme Justices' Health
For the first time in her 25-year career on the Supreme Court, Justice Ruth Bader Ginsburg was not on the bench to start the new year. After the 85-year-old justice was operated on for lung cancer, she decided to work from home rather than return to the court two weeks after surgery. She's expected to make a full recovery and be back at the court soon. A fair amount is known about Ginsburg's cancers and surgery, but the history of Supreme Court justices and their health is murkier. (Totenberg, 1/23)

The Washington Post: Democrats And Their Voters Have Shifted Left As 2020 Nears. They’re Betting The Rest Of The Country Follows.
The last time Democrats scouted for a presidential nominee who could strip the White House from Republicans, the party supported additional fencing along the U.S.-Mexico border. Same-sex marriage was illegal in 49 states, and few Democratic candidates were pushing to change that. And only one long-shot presidential hopeful talked about “Medicare-for-all.” A dozen years later, Democratic candidates and potential ones now argue that more barricades are not what is needed at the border. Candidates who once dodged questions about same-sex marriage now support it and are calling for greater protection of transgender individuals. “Medicare-for-all” — or something like it — has become standard, along with promises to combat racism, sexism and global climate change. (Weigel and Johnson, 1/22)

The Associated Press: Poll: Support For 'Medicare-For-All' Fluctuates With Details
"Medicare-for-all" makes a good first impression, but support plunges when people are asked if they'd pay higher taxes or put up with treatment delays to get it. The survey, released Wednesday by the nonpartisan Kaiser Family Foundation, comes as Democratic presidential hopefuls embrace the idea of a government-run health care system, considered outside the mainstream of their party until Vermont independent Sen. Bernie Sanders made it the cornerstone of his 2016 campaign. President Donald Trump is opposed, saying "Medicare-for-all" would "eviscerate" the current program for seniors. (Alonso-Zaldivar, 1/23)

The Hill: Poll: 56 Percent Of Public Supports Medicare For All
Progressives are pushing the new Democratic House majority to move forward on the idea, and many Democratic presidential hopefuls have signed onto the idea as well. More centrist Democratic lawmakers remain opposed to the proposal, however. The poll finds that there are wide swings in support and opposition to the idea depending on how the question is asked. (Sullivan, 1/23)

The New York Times: V.A. Wait Times Now Shorter Than For Private Doctors
Wait times for an appointment at Veterans Affairs hospitals have decreased since 2014 and are now, on average, shorter than those in the private sector, a new study shows. Researchers used V.A. data to calculate wait times for about 17 million appointments. The public sector data came from a survey conducted by a physicians’ search firm in nearly 2,000 medical offices in 30 major and midsize metropolitan areas. (Bakalar, 1/22)

The Hill: HHS Chief Refuses To Testify On Child Separation Policy
The Department of Health and Human Services (HHS) is refusing to have secretary Alex Azar testify before the House Energy and Commerce Committee about the administration’s child separation policy, according to the panel’s chairman. “[Azar’s] denial to appear before the Committee in the coming weeks on the family separation policy is unacceptable, and we are going to get him here at some point one way or another,” Rep. Frank Pallone Jr. (D-N.J.) said in a statement. (Weixel, 1/22)

Politico: Trump's Health Secretary Refuses Democrats' Request To Testify On Separated Kids
House Energy and Commerce Chairman Frank Pallone (D-N.J.), who announced earlier this month plans to hold a hearing on the administration's separation policy, had personally asked Azar to testify, a committee spokesperson told POLITICO. Azar's office declined the request Tuesday afternoon, the spokesperson said. "It has been eight months since this cruel policy came to light, and Secretary Azar has yet to appear before Congress at a hearing specifically on this policy," Pallone said in a statement, calling Azar's refusal "unacceptable." (Diamond, 1/22)

The Associated Press: Lawyers: Immigrant Kids' Detention Is Prolonged, Unexplained
Immigrant advocates said Tuesday they are suing the U.S. government, claiming it is detaining immigrant children too long and improperly refusing to release them to relatives. A federal lawsuit filed last year in Alexandria, Virginia, was expanded on Friday to propose including the cases of more than 10,000 children. (1/22)

The Hill: Grassley To Test GOP On Lowering Drug Prices
Sen. Chuck Grassley (R-Iowa) is giving Republicans an early test on their commitment to lowering drug prices. Legislation sponsored by the Senate Finance Committee chairman and Democratic Sen. Amy Klobuchar (Minn.) would allow people to buy prescription drugs from approved pharmacies in Canada. The bill is reigniting a long-simmering debate about drug importation, a proposal strongly opposed by the powerful pharmaceutical lobby. (Weixel and Hellmann, 1/21)

The Washington Post: Anonymous ‘Ghost Ship’ Is Among Groups Flooding Drug Pricing Debate
The political war over prescription drug practices is spawning a frenzy of activity by outside lobbying groups, some with names that mask their ties to industry and one that has gone to great lengths to disguise its origins. The increase in advertising, advocacy and pressure tactics is aimed at thwarting some efforts to control drug costs proposed in the Democratic-controlled House, such as allowing Medicare to negotiate drug prices, as well as ideas pursued by the Trump administration to curb prices. (Rowland and Stein, 1/22)

Reuters: U.S. Insulin Costs Per Patient Nearly Doubled From 2012 To 2016: Study
The cost of insulin for treating type 1 diabetes in the United States nearly doubled over a five-year period, underscoring a national outcry over rising drug prices, according to a new analysis shared with Reuters. A person with type 1 diabetes incurred annual insulin costs of $5,705, on average, in 2016. The average cost was roughly half that at $2,864 per patient in 2012, according to a report due to be released on Tuesday by the nonprofit Health Care Cost Institute (HCCI). (1/22)

Stat: Patients' Insulin Costs Doubled From 2012 Through 2016, But Usage Was Flat 
Specifically, individuals with Type 1 diabetes spent $5,705 on insulin in 2016, up from $2,864 in 2012, while the average daily insulin use rose just 3 percent, according to the Health Care Cost Institute, which analyzed about 15,000 claims from three large insurers — UnitedHealth (UNH), Cigna (CI), and Humana (HUM) — for each person who had at least one prescription for insulin. Meanwhile, the price of all insulin products increased during that four-year period. The average point-of-sale price – or out-of-pocket costs, such as deductibles, co-insurance and what insurers pay – nearly doubled, rising from $0.13 per unit to $0.25 per unit of insulin, which translates to an increase from $7.80 a day in 2012 to $15 a day in 2016 for someone using an average amount of insulin, or 60 units per day. (Silverman, 1/22)

Stat: Supreme Court Upholds Language In Patent Law, A Win For Generic Drug Makers 
In a unanimous ruling, the U.S. Supreme Court upheld disputed language in patent law that could lead to patents being canceled more easily, unless small drug makers and biotech companies more carefully construct deals involving their intellectual property. At issue was the intent of the America Invents Act, which in 2011 made several changes to U.S. patent law, and prohibits a company from patenting an invention if it was “on sale” for more than a year before filing a patent application. In this instance, the Supreme Court upheld an earlier ruling that Congress did not intend to change the law regarding sales. As a result, any sale or offer, whether publicly known or not, can lead to an invalidated patent, which is a victory for generic drug makers. (Silverman, 1/22)

Stat: PhRMA Spent A Record $27.5 Million On Lobbying In 2018 
The tally, as detailed in lobbying filings posted online on Tuesday, far outstrips the group’s previous record-setting spend, when it dropped a little more than $25 million in 2009, as Congress was deep in the debate over the Affordable Care Act. It spent just shy of that figure again in 2017. The group’s eye-popping 2018 spending — sums that support some two dozen internal lobbyists as well as a crowd of external contractors — is a sign of the increasingly existential threat the drug industry faces in Washington. The Trump administration has ramped up its efforts to address high prescription drug prices with a flurry of new regulations, and congressional lawmakers also spent the last year turning up the volume on their own criticism of the industry’s practices. PhRMA represents most of the nation’s largest drug companies, including Johnson & Johnson, Pfizer, and Merck. (Florko, 1/22)

Politico: Dems To Push Bill Raising Minimum Age To Buy Assault-Style Weapons
Democrats are introducing a bill that would raise the minimum age to buy assault-style weapons, the latest in a multipronged effort to address a string of recent mass shootings and stifle the gun lobby’s sway since taking back the House majority. The bipartisan bill, expected to be introduced by Rep. Anthony Brown (D-Md.) Wednesday, would prohibit anyone younger than 21 from buying semi-automatic rifles, with exceptions for active duty military personnel and some police officers. In most states, anyone 18 or older can buy what’s known as an assault-style weapon, even though the federal purchasing age for handguns is 21. (Caygle and Ferris, 1/23)

NPR: Supreme Court To Take Up First Gun Case In Nearly A Decade
With the Supreme Court now having five justices who are less likely to approve of gun regulations and laws, it granted a major gun case Tuesday for the first time in nearly a decade. The court granted a right-to-carry case out of New York that that pits the New York State Rifle & Pistol Association against the City of New York. New York bans transporting permitted handguns outside city lines, even if the gun is not loaded and is locked in a container. The guns currently can only be taken to the handful of shooting ranges within city limits. (Montanaro and Totenberg, 1/22)

The Associated Press: Judge Declares Iowa Fetal Heartbeat Law Unconstitutional
A state judge on Tuesday struck down Iowa's restrictive "fetal heartbeat" abortion law, which would have been the most restrictive anti-abortion law in the nation. Judge Michael Huppert found the law unconstitutional, concluding that the Iowa Supreme Court's earlier decisions that affirm a woman's fundamental right to an abortion would include the new law passed last year. (Pitt, 1/22)

Reuters: Iowa's 'Fetal Heartbeat' Abortion Ban Ruled Unconstitutional
In the ruling, posted online, District Court Judge Michael Huppert wrote, "It is undisputed that such cardiac activity is detectable well in advance of the fetus becoming viable." A fetus that is viable outside the womb, usually at 24 weeks, is widely considered the threshold in the United States to prohibit an abortion. (1/23)

The Wall Street Journal: New York Passes Abortion-Rights Bill On Roe V. Wade Anniversary
New York legislators passed a bill on Tuesday granting women the affirmative right to abortions under the state’s public-health law, a move that symbolically falls on the 46th anniversary of the landmark Roe v. Wade decision. The push comes partly as a reaction to the confirmation last October of U.S. Supreme Court Justice Brett Kavanaugh. Abortion opponents want Justice Kavanaugh at some point to provide the decisive vote striking down Roe v. Wade, the 1973 ruling that established a constitutional right to early-term abortions. (Vielkind, 1/22)

Reuters: Walgreens Pays $269.2 Million To Settle U.S. Civil Fraud Lawsuits
Walgreens Boots Alliance Inc will pay $269.2 million to settle two whistleblower lawsuits accusing it of civil fraud for overbilling federal healthcare programs over a decade, the U.S. Department of Justice said on Tuesday. The pharmacy chain will pay $209.2 million to resolve claims it improperly billed Medicare, Medicaid and other federal programs from 2006 to 2017 for hundreds of thousands of insulin pens it dispensed to patients it knew did not need them. (Stempel, 1/22)

The Wall Street Journal: Walgreens To Pay $269 Million On Claims It Overcharged Federal Programs
In the first settlement, Walgreens agreed to pay $209.2 million to the U.S. and several state governments for improperly billing Medicare, Medicaid and other federal health-care programs for hundreds of thousands of insulin pens it dispensed to program beneficiaries who didn’t need them, according to U.S. officials. Federal prosecutors said Walgreens configured its electronic pharmacy management system to prevent its pharmacists from dispensing less than a full box of five insulin pens, even when patients didn’t need that much. (Thomas, 1/22)

The Associated Press: Pass It On: Cigna CEO Says Leadership Evolves As You Advance
David Cordani became CEO of one of the nation's largest health insurers at age 43 and remembers clearly that no one gave him a textbook explaining the role. The now 52-year-old executive has helped his company, Cigna Corp., grow and diversify as the health care sector grapples with perpetually rising costs. Revenue at Cigna has more than doubled since Cordani took over in late 2009, and the company recently closed a $52-billion acquisition of the pharmacy benefits manager Express Scripts. (Murphy, 1/22)

The Associated Press: Insider Q&A: Cigna CEO Seeks Deeper Push Into Patient Health
Call Cigna a health insurer, and CEO David Cordani will try to correct you. He doesn't consider the company a pharmacy benefit manager either, even though Cigna just spent roughly $52 billion on one of the country's biggest prescription processors, Express Scripts. (Murphy, 1/22)

The Associated Press: Johnson & Johnson Puts Up Strong Profit And Revenue In 4Q
A big jump in prescription drug sales, particularly overseas, helped Johnson & Johnson swing to a large fourth-quarter profit after posting a huge loss a year ago, when it took a $13.6 billion charge related to the late-2017 U.S. tax overhaul. The world’s biggest maker of health care products also benefited from an effective tax rate of just 2.6 percent for the latest quarter, along with reduced spending on research and development. It topped Wall Street profit and revenue expectations. (Johnson, 1/22)

The Wall Street Journal: Johnson & Johnson Expects Sales Growth To Slow
Johnson & Johnson said it expects its sales growth to slow in 2019, citing pricing pressures and generic-drug competition for its pharmaceutical division. The health-products company, whose financial results are considered a bellwether for many health sectors, said Tuesday it expects full-year sales of $80.4 billion to $81.2 billion. For 2018, J&J said its sales rose 6.7% to $81.6 billion. (Loftus and Chin, 1/22)

The New York Times: What Is Toxic Masculinity?
For decades, we used terms like “macho,” “red-blooded” or “machismo” to describe the kind of hulking masculinity that men were, on some level, expected to aspire to. Now we have “toxic masculinity” — an expression once relegated to women’s studies classrooms that suddenly seems to be everywhere. (Salam, 1/22)

NPR: Multiple Sclerosis: A Misguided Immune Attack On Myelin
As the story goes, nearly 80 years ago on the Faroe Islands — a stark North Atlantic archipelago 200 miles off the coast of Scotland — a neurologic epidemic may have washed, or rather convoyed, ashore. Before 1940 the incidence of multiple sclerosis on the Faroes was near, if not actually, zero, according to the tantalizing lore I recall from medical school. Yet in the years following British occupation of the islands during World War II, the rate of MS rose dramatically, leading many researchers to assume the outbreak was caused by some unknown germ transmitted by the foreign soldiers. (Stetka, 1/21)

Stat: With Human Drugs, A Startup Hopes To Deliver Precision Medicine To Dogs
When pet dogs are diagnosed with cancer, they typically get surgery, chemotherapy, or radiation — that is, of course, if their owner opts to treat it. Now, a Silicon Valley startup wants to offer precision medicine instead — by recommending targeted therapies that are normally used to treat humans. For a price tag in the low four figures, depending on the veterinary clinic, the One Health Company will sequence a dog’s tumor and generate a report with recommendations. (Robbins, 1/23)

The New York Times: To Fight Fatty Liver, Avoid Sugary Foods And Drinks
Overweight children with fatty liver disease sharply reduced the amount of fat and inflammation in their livers by cutting soft drinks, fruit juices and foods with added sugars from their diets, a rigorous new study found. The new research, published in JAMA on Tuesday, suggests that limiting sugary foods and drinks may be a promising lifestyle strategy to help alleviate a devastating condition linked to the obesity crisis that is spreading rapidly in adults and children. An estimated 80 million to 100 million Americans have nonalcoholic fatty liver disease, which causes the liver to swell with dangerous levels of fat. Roughly seven million of those are adolescents and teenagers. (O'Connor, 1/22)

The New York Times: Even A 20-Second Exercise ‘Snack’ Can Improve Fitness
As little as 20 seconds of brisk stair climbing, done several times a day, might be enough exercise to improve fitness, according to a pragmatic new study of interval-style training. The study finds that people can complete a meaningful series of insta-workouts without leaving their office building or even changing out of their dress shoes, offering hope — and eliminating excuses — for those of us convinced that we have inadequate time, expertise, income or footwear to exercise. (Reynolds, 1/23)

The Wall Street Journal: Mayor De Blasio Drafts City Workers To Push Health Care Programs
New York City Mayor Bill de Blasio has given the city’s more than 344,000 workers a second job: Signing up residents for low-cost and affordable health insurance. Mr. de Blasio, a Democrat, signed an executive order on Tuesday to formalize a push by his administration to enroll uninsured New Yorkers in health plans. Under the order, on-duty employees at all city agencies will be required to educate residents they meet about city-run health plans and other resources. (Honan, 1/22)

The Washington Post: Portland-Area County Declares Emergency Over Measles Outbreak In Anti-Vaccination 'Hotspot'
A quickly escalating measles outbreak around Portland, Ore., has led health officials in nearby Clark County, Wash., to declare a public health emergency as they warn that people infected with the highly contagious virus since the beginning of the year have visited schools and churches, a dentist’s office, an Amazon locker pickup station, a Costco, and an Ikea. Someone with measles was at Concourse D of the Portland International Airport on Jan. 7, the county’s public health department advised. An infected person attended a Portland Trail Blazers home game on Jan. 11. (Stanley-Becker, 1/23)

Minnesota Public Radio: Rural Hospitals Retreat From Delivering Babies; Small Towns Pay The Price
Living deep in the Minnesota woods near the Canadian border, Tamer and Yvette Ibrahim took pride in being ready for whatever the wilderness could throw at them. Then came baby Zein, a blizzard and a white-knuckle ride to the hospital. Yvette Ibrahim's complicated pregnancy created unexpected challenges, including five-hour drives to Duluth and back each month for checkups. It was mostly manageable until the December 2016 night when her water broke. Heavy snow blew across the Arrowhead darkness, but Zein wouldn't wait. (Richert, 1/22)

Los Angeles Times: LAUSD Teachers' Strike Ends. Teachers To Return To Classrooms Wednesday
The Los Angeles teachers union ended its strike Tuesday night, based on overwhelming support for a contract agreement with the school district, union leaders said. Teachers, nurses, counselors and librarians will be back in their classrooms Wednesday, said Alex Caputo-Pearl, president of United Teachers Los Angeles. “A vast supermajority are voting yes for the agreement that we made,” said Caputo-Pearl, who also acknowledged that many votes still were being tallied. (Blume and Kohli, 1/22)

The Associated Press: Psychotherapist Challenges Maryland’s Conversion Therapy Ban
A Virginia-based psychotherapist is suing to overturn Maryland’s ban on conversion therapy for minors, saying it prevents him from taking clients with an “unwanted same-sex attraction.” The Baltimore Sun reports Christopher Doyle filed a federal lawsuit Friday, arguing the ban adopted last year violates his rights, as well as clients’ rights “to prioritize their religious and moral values.” The American Psychological Association opposes therapy seeking to change sexual orientation, saying it doesn’t work and can cause harm. (1/22)